Abstract:The epidemiology of community-acquired (CA) and health care-associated (HCA) Methicillin-resistant Staphylococcus aureus (MRSA) infections were investigated in a prospective 3-year (2004-2006) surveillance study in Uppsala County. MRSA was isolated from all patients with soft tissue lesions attending hospitals and primary care clinics, as well as by systematic screening, regardless of symptoms, from all patients seeking medical care who had been treated abroad. Pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST) and spa typing were performed. The Panton-Valentine leukocidin (PVL) gene and resistance profiles were recognised. The cost of bacterial analysis was calculated. During the surveillance period, isolates were collected from 7 967 individuals of whom 82 were colonised or infected with MRSA.(24 HCA and 58 CA). A majority (65%) of the MRSA isolates originating outside Sweden. The isolates could be assigned into nine well-known international clones. The most frequent clone was CC8 (32%) within four clusters were identified and equally distributed between HCA and CA-isolates. The next most frequent clone was CC80 (DK E97-1) (23%) only discovered in CA isolates. Resistance to antibiotics other than -lactams was found in 25% of the domestic isolates and in 60 % of isolates originating abroad. None of the HCA isolates carried the virulence determinant PVL gene. There was no spread of MRSA in the community or in hospitals during the surveillance period. Most domestic cases had certain risk factors. Travellers from or family relatives in the Middle East or Asia were highly overrepresented. To save costs selected screening is recommended.

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In a 6-year prospective epidemiological intervention study the spread of pneumococci non-susceptible to penicillin (PNSP) was studied among children attending day-care centres (DCCs). A primary aim was to investigate whether there was a risk for spread of PNSP by permitting children carrying PNSP strains to remain in the DCC. Carriers were followed until they presented negative cultures. The PNSP strains were characterised by serotyping, antibiotic susceptibility testing and clonality. Thirteen children with PNSP, initiated sampling of 321 children, 66 DCC personnel and 149 family members. Twenty-three (7 %) asymptomatic carriers were identified but none among the personnel. The most spread serotype was 6B (47%), followed by 19F (17%) and 9V (14%). The PNSP isolates were resistant to three antibiotics or more (69%). The spreading capability and duration of carriage differed between PNSP clones but no long-term risk for increased spread of PNSP in DCCs by carriers was found.

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Background: The aim of this study was to compare the impact of the pandemic influenza strain A(H1N1)pdm09 on the need for hospital care, intensive care and mortality in three countries in the southern hemisphere where no vaccination was implemented with the results obtained in Uppsala county, Sweden, where vaccination with the pandemic vaccine Pandemrix was started two weeks before the begining of the outbreak. Methods: In Sweden pandemic influenza A(H1N1)pdm09 was notifiable from the microbiology departments. Notification from the clinicians was required for patients treated in the hospitals. Data on mortality was extracted from the patients electronic journal systems. The data from the three southern hemisphere countries was obtained from a data analysis made by the Swedish Institute for Infectious Disease Control and was distributed on August 17th 2009 to all hospitals and county medical officers in Sweden. Results: The 2009 A(H1N1) influenza pandemic resulted in a lower need for hospital care in two out of three countries from the southern hemisphere compared with Uppsala county. In contrast, the need for intensive care and the mortality rate in the three countries where no vaccination was performed was similar to those of Uppsala county, where 62% of the population had been vaccinated by January 2010. Conclusions: No clear benefit could be registered on the need for hospital care, intensive care and mortality of the massvaccination campaign implemented in Uppsala county. This is probably due to the late onset of the vaccination campaign. After the vaccination campaign 7 new cases of narcolepsy was diagnosed in Uppsala county.